The Emerging Role of Robotic Surgery among Minimally Invasive Surgical Approaches in the Treatment of Hypopharyngeal Carcinoma: Systematic Review and Meta-Analysis

Abstract

The aim of this systematic review with meta-analysis was to investigate the available literature on transoral approaches in the treatment of hypopharyngeal squamous cell carcinoma, with a special focus on transoral robotic surgery (TORS). A systematic review was conducted according to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) check-list, and 15 studies were included. Five of the included studies evaluated TORS, while ten studies focused on transoral laser microsurgery (TLM) for the treatment of early or advanced stage hypopharyngeal cancer. Overall, survival rates of TLM and TORS studies, analyzed together in the cumulative meta-analysis, were 66.4% (95% confidence interval (CI) 54.3%–76.7%) at 36+ months of follow up. The TORS subgroup showed a higher cumulative survival rate (85.5%, 95% CI 55.8%–96.5%) compared to TLM (58.5%, 95% CI 46.6%–69.6%). Cumulative data showed that 29.3% (95% CI 24.0%–35.3%) of deaths were attributable to cancer. The results were similar between TLM and TORS studies. The larynx function preservation cumulative rate was 94.3% (95% CI 91.8%–96.1%). The results were similar among the two subgroups. The present review supports the use of transoral approaches in the treatment of hypopharyngeal cancer. TORS is oncologically sound and provides excellent functional results with low complication rates.

Patienten-Benefit und Lebensqualität nach Roboter-assistierten Operationen im Kopf-Hals-Bereich

“…In den Studien, welche insgesamt 112 Patienten einschlossen, war ein Larynxerhalt über die Dauer des Nachbeobachtungszeitraums in über 90% der untersuchten Fälle möglich. Ähnliche Ergebnisse wurden mittels TLM erzielt 209 . Neben dem Organerhalt steht bei Patienten mit Hypopharynxkarzinomen in Bezug auf die Lebensqualität insbesondere das post-operative Schluckvermögen im Vordergrund.…”

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“…40 Similarly, non-inferiority in terms of survival has been demonstrated in a meta-analysis for hypopharyngeal squamous cell carcinoma, comparing TORS to TLM. 41 Further randomized studies to assess this are certainly required; however, lack of precision in flexible CO 2 LASER remains a problem.…”

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“…Also, the authors found shorter hospital stays and faster recovery of safe swallowing with TORS hypopharyngectomy. In a systematic review and meta-analysis, De Virgilio et al [58] investigated the role of minimally invasive surgical approaches such as TLM and TORS for the treatment of hypopharyngeal carcinoma. At 36 months follow-up, the cumulative survival rate for TORS and TLM subgroups was 85.5% and 58.5%, respectively.…”